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Out of Balance?

Poor balance and the fear of falling are primary reasons for declining mobility as a person ages.  Mobility is an important factor in the quality of life.  As balance worsens (increasing the risk of falling), it is more difficult to be mobile.  Unfortunately, falling is the number one cause of hip fracture.  Nearly 20% of all hip fractures in the elderly will result in death within the first year, and 50% of people will never regain their prior level of function.

Physical therapy is a very viable and helpful resource in improving balance and mobility in order to maintain your independence.  The key to helping someone improve balance is to understand why his/her balance is worsening in the first place.  Determining the best intervention to address balance-related issues can be difficult and is typically multifactorial.  Once the reason for the decline is determined, an effective treatment program can be designed by the physical therapist to address the issue.  The following different body systems affect balance:

  • Musculoskeletal System – A person needs to have adequate strength and bone structure for mobility and balance.
  • Somatosensory – This system consists of all of the touch and nerve receptors in the muscles, tendons, and joints. A common problem affecting the somatosensory system is neuropathy. One very common form of neuropathy is from diabetes. Having numb feet makes it very difficult to balance!
  • Eyesight – We rely heavily on our eyesight for mobility and to know where we are located in our environment. Eyesight can be affected by eye conditions such as glaucoma, cataracts or even if you wear poorly fitting eyewear. Your eyesight is not just about the acuity at which you see, but is also how the eyes move. Gaze stabilization is how well you can stabilize on a target in your field of vision.
  • Vestibular System – Our vestibular system is located in our inner ears. It provides us with information on head movement. It works to process information on the head’s position in your environment. The vestibular system is one of the more adaptable systems, and with practice, it can be improved.
  • Central Nervous System – The brain is responsible for coordinating all of the information gathered by the body’s other systems. Damage from trauma or conditions, such as Parkinson’s disease, or a stroke can also affect balance. Other factors such as medications and dehydration can also affect balance.

Fitness group doing tai chi in park on a sunny day

One of the best ways to maintain your balance as you age is to remain active and move more!  Balance is an integration of many body systems, so movement is an excellent way to work on all of the body systems!

If you desire specific advice, I highly recommend that you seek assistance from a qualified medical doctor or physical therapist that is well versed in balance related disorders.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

For additional information on the five different body systems which affect balance and how they work together to insure proper balance and mobility in our environment, please refer to How Do I Improve Balance? (Part I), How Do I Improve Balance? (Part II), and How to Improve Balance Using a Water Noodle.

How do you incorporate balance activities into your therapeutic exercise program? Please leave your comments below.

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If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

(This article first appeared in the Seniors Blue Book, October 2014-March 2015, page 84.)

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How to Train for an Obstacle Course Race

Obstacle course racing (OCR) is growing quickly and becoming a very popular sport.  It is a fun way to challenge your strength, fitness, and mental fortitude.  With the proper training and recovery, this style of racing can be performed safely.  Whether you are a newbie or a seasoned Spartan, I offer tips on how to optimize your racing experience.

(Courtesy of Reebok Spartan Race)

(Courtesy of Reebok Spartan Race)

I competed in my first OCR, the Boise Spartan Sprint, thanks to a friend.  She transferred her registration to me after suffering a knee injury and was unable to participate.  Thank you, Jenifer, for prompting me to try something new!  It was a blast!

How to prepare for an OCR?  Without any prior experience, I started by listening to Ben Greenfield’s Obstacle Dominator Podcast and reading about Spartan Race Training.  I have competed in many running and trail races at varying distances, so I felt that I could adequately train despite being on a long vacation the two weeks prior to the race.

The Boise Spartan Sprint

Obstacles, courses, and distances vary for each event.  This particular course offered options to skip certain obstacles, but you had to pay a 30 burpee penalty.  Although there were options available to insure all who wanted to participate could, the terrain was not suitable for everyone.  There were five quite steep hills to climb up and down during the 4 mile course.  They were much steeper than I expected, and I’m used to hiking similar terrain while hunting.

SpartanSprint_Hills

The other surprise was how the water obstacles made for a new challenge (particularly when combined with other obstacles such as the rope climb).  I am typically a pretty good rope climber, but getting a good foot hold was difficult when submerged in 3 feet of water.  Fortunately, I was able to overcome the challenge.

After experiencing the general tempo of this particular course and its layout, I better understand how to train for an OCR.  My final ranking was number 180 out of 3,394.  Not too bad for a first attempt, but nothing like the elites!  I will be sure to incorporate more of these tips and lessons learned when training for my next OCR.

Finisher

7 Tips on How to Train for an Obstacle Course Race:

  1. High intensity interval training (HIIT). The amount of HIIT in preparation for your race will vary and is dependent on the distance. If the race course will be a shorter distance (under 5 miles), then a majority of your running could be HIIT and shorter distance recovery runs. If you will be competing in longer distances (10 miles or more), then I would still incorporate a weekly longer run just so your body will be prepared for the mileage and time on your feet. I highly recommend that you run outside–preferably on a trail or uneven terrain to prepare your legs adequately. You will need to feel comfortable running downhill on uneven terrain. Please refer to my Training Plan that I used for Race to Robie Creek, a very steep half marathon 8.5 miles uphill and 4.6 miles downhill.
  2. Train for the pack. In larger races or in races where there is a variation in skill levels, I recommend training for this variable. Constantly changing your running pace faster or slower is more tiring than just running at your preferred pace. One easy and effective running style to train for this variable is called the Fartlek, Swedish for speed play. It involves taking your normal forty to sixty minute run (after a warm up) and intermittently changing your pace from jogging (at different speeds) to sprinting. This can be performed in a structured form or randomly in true Fartlek style. One method is to pick objects in front of you and vary your running speed as you approach them. This is a critical training method if you want to improve your race time.
  3. CrossFit as a form of high intensity training (HIT) is an excellent method to train your legs to handle the hilly terrain (including a very fast and steep decent). The obstacles may include: picking up heavy objects and carrying them either in front or sometimes overhead; scaling walls; swinging and climbing along monkey bars; rope climbing; and crawling in mud. CrossFit taught me how to prepare for these different obstacles by refining the skill sets necessary to tackle them. It also prepared me to perform the obstacles when fatigued.
  4. Climbing Wall. One of the obstacles included traversing a climbing wall sideways for 20+ feet. Participants were not allowed to climb up or let their feet touch the ground. I suggest practicing this at a local climbing wall. Although I was able to perform the obstacle, I was much slower as I rarely spend time on a climbing wall.
  5. Monkey Bars. Spend time practicing swinging, climbing, and moving in different directions on monkey bars to better prepare for the different obstacles. It’s also an excellent method to increase your grip strength.
  6. Clothing can be an interesting variable. For my particular OCR, the temperature was quite warm (above 80 degrees). The water obstacles helped to keep my body cool. In hindsight, additional clothing should have been considered in order to avoid cuts and scrapes. I wore a long pair of compression socks to help with cramping and protection from ground cover. I wish that I would have worn knee protection. The crawling cut up my knees and made them feel sore. Also, when scaling the walls, I got scrapes under my arms because I wore a tank top. I recommend wearing clothing that will protect your body for the likely scrapes and cuts that will occur.
  7. Ankle Sprain Prevention. I had been warned that this particular course was hilly. In preparation, I decided to utilize Mummy Tape for ankle stability. (You can also use Rock Tape, KT Tape or any other Kinesiological style tape.) This video, KT Tape Ankle Stability, demonstrates the technique I utilized to help improve my ankle stability in order to prevent an ankle sprain. For application and removal tips, please refer to Skin Care with Taping.

Once you complete the OCR, enjoy your accomplishment, but don’t forget to implement proper recovery strategies!  Be sure to properly cool down after the race.  Don’t sit!  Stretch and continue to move.  You will need to make sure that any scratches or wounds are properly cleaned and covered.  Hydrate appropriately and begin working through your recovery process.  For more information on how to quickly recover, please refer to the following posts: 14 Tips and Strategies to Self-Treat Muscle Pain and Muscle Cramping & Spasms – Treatment Options.

Have you competed in an OCR before?  Please share your experience by leaving a comment below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Q & A: 10 Tips to Prevent Dementia

Q.  My mother had dementia, and I have heard that it can run in families. Is there anything I can do to prevent dementia?  – Judy

A.  Thank you, Judy, for the question. Dementia is a very popular topic lately, especially as cases of dementia continue to rise at a startling rate.  One aspect of the Physical Therapy Advisor web site is to provide “how to” advice on successful aging as well as how to manage your health and well-being.  Preventing dementia is definitely a critical component in successful aging and a healthy lifestyle.

Let’s first define exactly what dementia is, and then we will address the symptoms and risk factors.  Dementia is not actually a specific disease.  It’s a term used to describe a group of symptoms affecting a person’s memory or ability to perform activities of daily living (ADLs). There are six basic ADLs: eating, bathing, dressing, toileting, transferring (walking), and continence.

At least two brain functions, such as memory loss and impaired judgement, need to be affected for a person to be diagnosed with dementia.  A person may experience memory loss along with difficulty of performing ADL tasks, such as how to cook or drive.  Loss of memory only would not necessarily mean that a person has dementia.  Although there are many potential causes of dementia, Alzheimer’s disease is the most common form of dementia.  Other possible causes include:

  • Vascular dementia
  • Lewy Bodies dementia
  • Frontotemporal dementia
  • Parkinson’s dementia
  • Huntington’s dementia
  • Hydrocephalous
  • Dementia like symptoms caused by nutrient deficiencies or reactions to medications

Dementia is a serious health problem facing many industrialized nations including the United States.  Actual numbers of people diagnosed with dementia vary between 2 and 5 million people.  Even more troubling is that 5-8% of people over the age of 65 have some form of dementia and that number doubles every 5 years after the age 65.

Close Up Portrait of Worried Senior Couple

Symptoms of Dementia may include the following:

  • Memory loss
  • Difficulty communicating
  • Difficulty with complex tasks, such as driving or math
  • Difficulty with motor programming or coordination
  • Easily disoriented or getting lost easily
  • Personality changes
  • Difficulty with logic or reason
  • Loss of safety awareness or judgement
  • Paranoia
  • Agitation
  • Hallucinations

Dementia like symptoms should be evaluated by a medical physician and should be openly discussed with all parties involved.  Many forms of dementia are progressive.  Early diagnosis allows for proper planning and time to make crucial decisions.  Depending on the type of dementia, there may be medical options to slow down the progression.  In addition, some causes of dementia like symptoms are reversible if caught early.  Your physician can assist you in determining your specific diagnosis and prognosis.

Risk Factors for Dementia:

  • Age – Dementia can occur at any age, but the risk significantly increases after the age of 65. Dementia is not considered a normal aging process.
  • Family History – Genetics play a role. A family history of dementia and certain specific genetic mutations increase your risk.
  • Down syndrome – Down syndrome increases your risk of developing dementia.
  • Alcohol Abuse – Heavy drinking and alcohol abuse increases your risk. Mild to moderate alcohol consumption may help to prevent dementia (particularly when consumed in the form of red wine).
  • Microvascular diseases such as diabetes or atherosclerosis, which is the fatty build up in the arteries. Any disease process that has an inflammatory effect on the small blood vessels of the body increases your risk.
  • High Blood Pressure
  • Depression
  • Hearing Loss
  • Obesity
  • Smoking

Now that we have identified exactly what dementia is and many of the risk factors that increase your risk for developing dementia, let’s address Judy’s question regarding prevention.

10 Tips to Prevent Dementia:

  1. Eliminate known risk factors. This includes eliminating smoking and avoiding heavy alcohol consumption.
  2. Stay social. To experience purpose in your life, it’s key to maintain your social outlets and friendships. It also helps to decrease your risk of developing depression, which is a risk factor for dementia. Be active in your community by interacting with family, friends, church, civic organizations or volunteer projects.
  3. Maintain sharp mental health. Regardless of age, it’s important to remain engaged and mentally sharp through constant and varied mental stimulation. Read, play engaging games, and avoid excessive TV watching.
  4. Get hearing aids. Poor hearing is associated with an increased risk of dementia. When a person loses his/her hearing, he/she tends to disengage with the environment. He/she becomes less social, more depressed, and no longer participates in stimulating activities. Stay engaged by quickly addressing hearing loss.
  5. Exercise. Walk daily or take a yoga or Tai Chi class. Participate in a strength training and high intensity training (HIT) program. Exercise can help you to maintain a suitable weight by insuring your metabolism stays elevated and your hormone levels remain balanced. It also insures good blood flow to the smaller vessels in the brain and helps to regulate insulin levels, which prevents diabetes (a risk factor for dementia).
  6. Do not eat anything that comes in a package. Most of our food should be from low sugar fruits and vegetables as well as protein and healthy fats (primarily from plant sources such as avocados and coconut or olive oil). Any animal fat should be from organic and grass fed animals. Your brain and body tissue need nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development.
  7. Stay hydrated. The human body is primarily made of water, which is critical for all body functions. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Water intake supports proper brain, muscle, and hormone function as well as lubrication of the joints and skin appearance. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names that you can’t spell or pronounce.
  8. Manage your weight. Obesity places additional strain on your cardiovascular system and increases your risk of diabetes—thus increasing your risk of stroke, heart disease, and dementia. When attempting to lose weight, aim for 1-2 pounds per week.
  9. Sleep more. While sleeping, your brain clears out metabolic waste, known as neurofibrillary tangles, which are associated with dementia. Your body must rest in order to grow and develop. Most people are not getting adequate sleep and rest. Sleep is critical to maintaining your growth hormone and testosterone production as well as stabilizing your metabolism.
  10. Supplements. There is some evidence that certain vitamins, minerals, and/or herbal supplements may help to reduce your risk of dementia. Folic acid, vitamin B12, vitamin D, magnesium, and fish oil are believed to preserve and improve brain health. Although results are less conclusive, vitamin E, ginkgo biloba, coenzyme Q10, and turmeric may also be beneficial in the prevention of or delay the onset of dementia like symptoms. Please consult with your healthcare practitioner to determine if these supplements are ideal for you.

Dementia is quickly becoming a major public health crisis.  The risk for developing dementia rapidly increases as baby boomers (and others in the western world) age.  Although the exact cause of the spike in dementia cases is unknown, it’s pertinent that we live a healthy lifestyle and avoid known risk factors.  To learn more about how to age successfully, please refer to My Top 10 Anti-Aging Tips.  For inspiration regarding the aging process, I also recommend reading Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.  Thank you, Judy, for this question!

Do you have a loved one or friend who is experiencing dementia?  Which tip will you implement in order to prevent dementia?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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12 Strategies to Prevent and Self-Treat Muscle Cramping

MTA_MuscleCramping

http://marathontrainingacademy.com/muscle-cramping

Marathon Training Academy

June 16, 2015

In this guest post for Marathon Training Academy, you will discover the common causes for muscle cramping and learn prevention strategies and self-treatment tips.

RunningInjuryOnCalfMuscle cramping and spasming can significantly derail your best intentioned race plans.  A muscle cramp or spasm is a sudden, involuntary, and typically severe muscle contraction.  Thankfully, it’s very rare for a muscle spasm or cramp to permanently damage the muscle.  However, the cramp or spasm can produce mild to excruciating pain.  The pain can be very short lived or linger for days after a severe episode.  Unfortunately, muscle cramping can affect your performance.  Common causes of muscle cramping include overexertion, prolonged immobility, dehydration, and electrolyte imbalances.  Continue Reading

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Why Walking is Critical for Your Health

Walking is a wonderful method of exercise.  Out of all the possible movements humans can perform for mobility, we are best at walking! Since most of us started at a very early age, we are familiar with walking.  It has different purposes and offers many benefits.  We walk to get somewhere, to have fun, to relax, and to exercise.  Compared to other activities, walking is easy on your body and can fit into your busy schedule.  Walking daily can reduce stress, improve circulation and hormone regulation as well as benefit your overall well-being. It just makes you feel good!

As we consider what it means to age successfully, we must look at our ability to live safely, independently, and comfortably regardless of age.  In order to age successfully, we must be intentional about the process.  A walking routine can help you to manage each of these critical components to successful aging including: physical health, mental health, emotional health, community, and finances (particularly if leading a healthy lifestyle helps you to avoid the ever growing costs of health care).

Almost anyone can walk, even those who may have a temporary or permanent medical condition which doesn’t allow for other forms of exercise. Walking can still be appropriate for those with the following conditions:

  • Certain Forms of Arthritis – There are 171 different kinds of arthritis. Although causes and presentations vary, the most common form is osteoarthritis (OA). Regular exercise and a range of motion (ROM) program is a critical component to proper management of arthritis. For more information specifically on Rheumatoid Arthritis, please refer to Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis.
  • Joint Replacement – As America’s population continues to age, total joint replacement has become an increasingly more popular method to treat pain and arthritis in joints.
  • Morbid Obesity – Morbid obesity is defined as a Body Mass Index (BMI) greater than 40 or having more than 100 lbs. of body weight.
  • Recent Medical Procedures or Injury – Often after a medical procedure, physicians will advise not to run or participate in overly strenuous exercise during recovery. Walking is nearly always indicated as part of a recovery process (particularly after spinal surgery). Many lower leg surgeries may indicate a reduced or non weight bearing time period when walking isn’t recommended. Always refer to your physician and physical therapist regarding when to avoid activity. Once you have sufficiently healed, you can taper back into your prior level of activity and walking program. Your physician or physical therapist can offer advice on how to safely resume your activities.
  • Chronic Injury or Illness – Past injuries or illness can cause permanent injury and debility. Sometimes it may cause someone to have to permanently alter his/her ability to participate in more high impact activities. Other forms of chronic disease, such as fibromyalgia, may make intense exercise unreasonable. In almost all of these cases, a walking program may be indicated.
  • Severe Osteoporosis – Osteoporosis is the weakening of the bones. Besides dietary modification, the best course of treatment is weight bearing activities such as weight training and walking.

Recreation

Walking is a wonderful form of exercise.  Regardless of your age and fitness level, I believe walking should be part of a healthy lifestyle.  Many of the benefits of walking overlap.  Improving your circulation and hormone function will have a positive effect on other areas of your health.

What are the benefits of walking?

  • Lowers the risk of heart disease, stroke, and diabetes.
  • Lowers your risk of cancer, including breast cancer.
  • Improves circulation and blood flow to the entire body.
  • Releases stress reducing hormones.
  • Releases hormones that can control blood sugar levels for up to 24 hours. This helps to reduce your risk of diabetes while keeping your energy levels stable throughout the day.
  • Keeps your mind sharp and reduces your risk of Alzheimer’s disease and dementia.
  • Boosts your immune system.
  • Improves sleep quality.
  • Reduces pain levels.
  • Helps to manage arthritis symptoms. Please refer to Exercise is an Effective Treatment for Knee Arthritis Pain.
  • Helps to maintain your eyesight and avoid cataracts through improved circulation.
  • Reduces the risks of periodontal disease.
  • Burns calories.
  • Helps to prevent constipation.
  • Walking in a fasted state can help your body to learn how to utilize fat more efficiently as an energy source.
  • We are naturally good at walking. Do it daily!
  • It is a weight bearing activity that can be beneficial in reducing osteoporosis.
  • Keeps the spine healthy. The walking motion is vital to nutrient exchange in the spinal discs.

Typical guidelines suggest walking for 30 minutes per day, five or more times per week.  The recommended 30 minutes per day doesn’t need to be performed all at once.  I highly encourage you to walk more than 30 minutes–just in shorter sessions throughout the day.  When formulating a walking plan, look for ways to add a short distance here and there.

As part of a regular exercise plan, walking in the morning can be an excellent method to help energize your day by starting out on the right path mentally and emotionally.  If performed prior to breakfast, walking also has the additional benefit of helping to regulate your appetite.  When performing low intensity exercise in a fasted state, your fat burning capability increases while your hormone levels stabilize.  Walking after dinner has a similar effect on hormone levels (particularly with stabilizing insulin levels).

If you want to increase the amount of calories burned during a walk, you may need to make a few changes to your morning or evening stroll.  Don’t walk at your preferred speed.  The trick is to make your body inefficient by walking slower, faster, uphill, downhill, or at varying speeds.  Perform a high intensity workout by walking uphill briskly or using the Fartlek method.

Nordic walking, which utilizes walking poles that can help to stabilize you if your balance is poor, is also very popular. The use of walking poles can reduce stress from your back and lower extremity joints, increase your body strength, and burn more calories than traditional walking!

The most important component of a walking program is actually doing it!  If you are unable to ambulate safely or need an assistive device to ambulate safely, walk with a friend or group.  You may consider walking in safe location, such as a shopping center or mall, to avoid environmental hazards.  With a little thought and preparation, walking can be possible for nearly everyone.  If you are experiencing issues with balance, safety or other orthopaedic concerns, please consult a physical therapist.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Choose walking as an intentional exercise and add it to your daily activities as part of a healthy lifestyle.  You will feel better and likely live longer when you incorporate this critical component to aging gracefully and successfully.

Which benefits have you experienced from your walking program? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Q & A: My Top 10 Supplement Recommendations

Q.  Ben, you often recommend different supplements as part of treatment recommendations as well as for sports performance or recovery. Which supplements do you actually use?  -Seth

A.  Thanks, Seth, for this excellent question! Opinions on the best supplements to use vary widely and can be quite controversial. Your dietary belief system and what type of exercise or activity you mainly participate in will determine which supplements may work best for you.

I tend to use certain supplements, such as protein, coconut oil, magnesium and super greens, on a regular basis.  I take Creatine more intermittently as part of a cycling protocol.  I use other supplements intermittently for a specific purpose such as fueling for a long run or improved recovery.  I have tried many different types of supplements.  I have personally experienced the most benefits from consuming these specific supplements.

ProteinPowder

My Top 10 Supplement Recommendations:

1.  Protein.  I prefer to supplement with a plant-based protein source because I regularly consume animal-based protein.  Lifetime Life’s Basics Plant Protein is an organic vegan option that contains a blend of proteins which makes a complete amino acid profile. I prefer the vanilla, but it’s available in chocolate as well. It doesn’t have any other preservatives, chemicals or sweeteners. If you are used to mass produced supplements, your taste buds will have to adjust.

I also supplement with a goat-based protein source.  Goat protein is a smaller particle size and may be more easily digested and utilized by the body.  Mt. Capra Double Bonded Goat Milk Protein is an organic goat-based protein. Mt. Capra offers multiple flavor options. I prefer the chocolate, which is only flavored with organic cocoa powder. It doesn’t have any preservatives, chemicals or sweeteners. Again, if you are used to mass produced supplements, your taste buds will have to adjust.

If you’re interested in a whey supplement, Thorne Research Whey Protein Isolate doesn’t contain artificial flavors, colors, sweeteners, carrageenan or gluten. It is sourced from cows not treated with hormones.  For more information on protein supplementation, please refer to How Much Protein Do I Really Need?

2.  Amino Acids. Branch chain amino acids (BCAA) are the building blocks to protein. Runners and endurance athletes should pay particular attention to protein intake as maintaining muscle mass is critical for performance and injury prevention. Consuming amino acids before and during endurance events is an excellent method to keep your blood sugar stable and to maintain a high level of performance. It is also muscle sparing. You are more likely to metabolize energy from fats or carbohydrates stores (rather than muscle) when there are plenty of BCAA particles floating around in your digestive system and blood stream. I often combine supplementing BCAA with a carbohydrate fuel source such as Generation UCAN SuperStarch. If you prefer a ready-made product, I recommend Hammer Nutrition Perpetuem Ultra Endurance Fuel, which includes a carbohydrate source, protein, and fat source, and Hammer Nutrition Hammer Gel, which contains some amino acids.

3.  Creatine.  Creatine monohydrate is helpful for increasing skeletal muscle size, strength, and power production.  It may also have a preventative effect for dementia and neurodegenerative diseases.  I recommend 5 g per day.  I typically consume it in 6-8 week cycles.

4.  CapraFlex.  My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra.  It combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently.  I use it to help recover from acute injury.  I also use it as a preventative measure when in periods of high volume or high intensity training (HIT).  For instance, I consume it during the final month of preparation for a race or an event.

5.  Generation UCAN SuperStarch.  Generation UCAN produces my favorite synthetic carbohydrate source.  Generation UCAN SuperStarch is a gluten-free complex carbohydrate that is non-GMO.  It has been specially formulated to stabilize blood sugar and not cause an insulin reaction.  I typically utilize this product for any prolonged activity which exceeds 1.5 hours.  Although it can be consumed throughout a race or prolonged activity, I typically consume a serving along with BCAA at the beginning of my activity.  If additional fuel is needed during a longer run which exceeds 2 hours, then I typically utilize Hammer Nutrition Perpetuem Ultra Endurance Fuel and Hammer Nutrition Hammer Gel.

6.  Magnesium.  I use magnesium as a sleep and recovery aid.  I consume it at night to help me sleep.  This has been a major benefit for me as it significantly reduces muscle soreness, cramps and/or spasms.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.  Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

7.  Cinnamon.  Cinnamon is a spice that has cholesterol lowering benefits and antifungal properties. It can reduce the proliferation of leukemia and lymphoma cancer cells. It has an anti-clotting effect on the blood which can reduce your risk of stroke or heart attack. Cinnamon may help treat Type 2 Diabetes by lowering blood sugar levels and increasing the amount of insulin production in the body.

The primary reason why I consume cinnamon is to stabilize blood sugar. Although I love the taste of cinnamon, you cannot eat enough to gain the noted health benefits. It must be consumed in a supplement form. I take about 1 g of cinnamon prior to consuming a high carbohydrate meal (particularly if I have not recently exercised). My blood sugar remains more stable, and I feel better between meals.

8.  Caffeine.  Many supplements contain caffeine.  If you avoid caffeine, then you should continue to do so.  Caffeine has many health and fitness benefits when used appropriately.  Caffeine has been proven to increase cognitive performance.  It may also help to mobilize fat stores, which aids your body’s ability to use fat as a primary fuel source.  Better fat utilization can help to stabilize blood sugar and increase your energy levels.  This may allow you to participate in longer bouts of exercise or push yourself harder during your high intensity training (HIT) workouts.

One way in which caffeine improves performance is by sparing glycogen.  Glycogen is your body’s preferred fuel source (particularly during the first 15 minutes of exercise).  The sparing of glycogen can help you to transition from primarily carbohydrate utilization to fat utilization.  Caffeine peaks in absorption approximately 45 to 60 minutes after ingestion, but it likely has a much longer effect on fat utilization.

Caffeine has also been shown to lower submaximal heart rate.  When considering a long distance event, this can be very beneficial in how long you can sustain your pace (meaning that you can push yourself harder for longer).  Unfortunately, it has not yet been proven to lower maximal heart rate during maximal exercise such as HIT.  This means its best indication for use is likely during submaximal activity such as distance running.  The approximate amount needed for ergogenic benefits is 3 mg of caffeine per kilogram of body weight or 3 mg for every 2.2 pounds of body weight.

If you weigh 150 lbs., divide that by 2.2 lbs. which equals approximately 68 lbs.  Next, multiple 68 lbs. by 3 mg for your needed caffeine dose.  In this example, 204 mg of caffeine is needed for a person who weighs 150 lbs. 

I recommend ingesting caffeine at least 15 minutes prior to your run and approximately every 45 minutes (depending how long you will be running).  I would not over consume caffeine as potential side effects include: poor sleep quality; gastrointestinal distress; headaches; muscle cramping; and dehydration.  Caffeine is a mild diuretic and can cause anxiety.  If you are already taking a diuretic, please consult with your physician about using caffeine as an ergogenic or cognitive aid.

9.  Super Greens.  Most people do not consume enough greens.  Green super foods, such as spirolina and wheat grass, are packed high in antioxidants.  They can have a cleansing and an alkalizing effect.  Super greens boost your immune system and are generally good for you.  Super greens should be consumed daily, but it’s particularly important to supplement with during times of high stress (including high training stress).  Amazing Grass Green SuperFood is easily consumed in a powder form and typically tastes best when mixed in with food.  I usually mix it into hot oatmeal or a smoothie.  You can also utilize a pill form.  Energy Bits is spirolina in a pill form.  I have utilized Energy Bits as part of a fueling plan for longer runs and activities with great success.  I found them to have a blood sugar stabilizing effect while keeping my energy levels high.  I also combined Energy Bits with Generation UCAN SuperStarch which seems to work particularly well.

10.  Coconut Oil.  I typically purchase Kirkland Organic Coconut Oil at Costco.  Nature’s Way Coconut Oil is another option. I typically mix a protein supplement into my black coffee along with a teaspoon of organic coconut oil, which is full of medium chain triglycerides (MCTs).  Coconut oil does not negatively affect cholesterol levels. It has no added flavor. It helps to stabilize my blood sugar and keeps me satiated for hours.

Coconut oil offers many health benefits including:

  • Helps to stabilize blood sugar
  • Helps metabolize energy stores more efficiently
  • May have protective effects on brain related disorders
  • Reduces the risk of illness and infections
  • Helps to control hunger cravings
  • Reduces the risk of seizures and heart disease
  • Moisturizes skin
  • Helps children’s brains develop by providing the correct nutritional building blocks for the nervous system

When choosing supplements, I tend to gravitate to supplements that can enhance performance, improve recovery, stabilize blood sugar or reduce inflammation.  The ultimate goal with supplements is to aid your body in improving health and/or performance.  Try to choose the most natural products as possible and experiment to see what works best for you.  For a glimpse into my medicine cabinet (and other recommended products that I personally use), please visit my Resource Guide.  Thanks, Seth, for your question!

What is your favorite supplement and why?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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Exercise is an Effective Treatment for Knee Arthritis Pain

Knee osteoarthritis (OA) causes chronic pain, reduces physical function, and diminishes quality of life. Obesity, prior injury, and increasing age are among the risk factors for knee OA, which is more common in women. Typical treatments for knee OA include total joint replacement and exercise. Medication management may include oral anti-inflammatory use, cortisone injection, and supplementation with glucosamine and chondroitin.

A recent meta-analysis of 54 randomized control studies, published in Cochrane Database (January 2015), concluded that therapeutic exercise provides a 2-6 month benefit even after cessation of the exercise program. This benefit is comparable to the use of non-steroidal anti-inflammatory drugs without the side effect risk from drugs. The study concluded that exercise is just as effective in treating knee OA pain as anti-inflammatory medication.

This most recent study looked at 2-6 month benefit when performing exercise. It is reasonable to conclude that long term therapeutic exercise continues to have a positive effect in pain management and functional loss well beyond the 2-6 month time frame. Performing therapeutic exercises improves physical function and alleviates pain levels with little risk. When properly performed, exercise doesn’t significantly increase the risk of further damage or deterioration in OA (or in most other forms of arthritis).

The study also indicated that individually tailored exercise programs tend to result in a greater reduction in pain as well as improvement in physical function. If you suffer from knee OA, initiating a therapeutic exercise program could be the best long term solution in managing the condition while maintaining function and quality of life.  A thorough therapeutic exercise program should include cardiovascular exercise, flexibility training, balance activities, and strength training. Seek guidance from a physical therapist, who can design an individually tailored exercise program to meet your specific needs.

Possible options for cardiovascular exercise include bicycling, rowing, and the elliptical machine. Less impact options include swimming and pool-based exercise programs. Exercise studies indicate the effectiveness of aquatic-based programs in reducing knee pain while improving general functional mobility. Performing a long term aquatic exercise program can be highly effective for managing knee OA symptoms. To insure maximal strength gains and carry over in functional mobility tasks (such as going up and down stairs, up and down curbs, and navigating uneven terrain), also incorporate a land-based program.Image courtesy of Pond5Flexibility is an important component in managing knee OA pain. The goal should be to maintain full knee range of motion (ROM) with both extension (straightening) and flexion (bending). A joint should be moved through its full available ROM daily to remain healthy. Activities such as aquatic exercise, cycling, yoga, and flexibility classes are ideal for maintaining ROM.

Balance is an important component to maintaining functional mobility and limiting pain in the knee. Performing therapeutic exercises and weight training will help you to maintain your balance. Additional balancing activities should be performed to insure safe mobility and to reduce the risk of falling. Activities, such as yoga and Tai Chi, have excellent research demonstrating their effectiveness. Practice standing on one foot (near a counter top for support, if needed). It is an easy and effective method to maintain single leg balance which is critical for going up or down stairs and sidewalk curbs.

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Strength training programs should include closed chain exercises. Closed chain exercises are closely related to functional movements and tend to cause less strain on your body tissues and joint surfaces. Squats, lunges, and bridging are examples of closed chain exercises. The bridge exercise involves lying flat on your back and raising your pelvis up into the air.

There are many variations of the squat. Perform sit to stands from a chair. If this is difficult, start with using your hands, but eventually you shouldn’t need to use them. Use a standard height chair and see how many sit to stands you can perform in 30 seconds.

For another squat variation, perform wall squats.  Stand with your pelvis, back, and head touching a wall.  Your feet will be approximately hip width apart and far enough out from the wall.  When you slide down, your knees will make a 90 degree angle.  From your starting position, slowly lower your body down and hold for time.  As you improve, lengthen the amount of time you hold the wall squat.  (Another variation is to place an exercise band around your thighs above your knees.  It will help to increase the activation of the hip muscles.)

Wall Squat

To maintain physical function and quality of life, a therapeutic exercise program (including cardiovascular, flexibility, balance, and strength training) may be the best long term solution for managing knee OA pain. Be certain to perform a thorough warm up and cool down before and after each exercise session. Focus on maintaining your ROM. If it hurts, modify or discontinue the activity, and refer to your physical therapist.

How do you incorporate cardiovascular exercise, flexibility training, balance activities, and strength training into your therapeutic exercise program? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

(This article first appeared in the Seniors Blue Book, April-September 2015, pages 106 and 107).

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Q & A: Is Weight Training Safe for Children?

Q.  My son is 11 years old and wants to start lifting weights with me. Is it safe for him to do this at such a young age?  -Matt

A.  Great question, Matt! I believe weight training and activity in general should be encouraged in whatever form the child prefers.  Research regarding the effects of heavy weight training or high intensity training in younger children continues to evolve.  The long standing belief that weight lifting will stunt a child’s growth has never been proven.  In fact, current research indicates that weight lifting may actual help to increase a child’s growth rate.  This may be due to hormonal improvements or actual physical stress (in response to the training) on the child’s body.  Most likely, the positive effect on growth rate is due to a combination of both factors.

When addressing weight training, keep in mind that children’s physical, mental, and emotional development will vary widely and is not necessarily correlated to their chronological age.  Most children will have varying degrees of muscle strength and asymmetry in that strength as they grow and develop.  Encouraging activity and exercise is a critical component to how the child will ultimately develop.  When choosing which type of activity and exercise is appropriate for a child, his/her physical, mental, and emotional development need to be considered.

Physiological considerations include:

  • Growth Plates. The epiphyseal plate (growth plate), which is a cartilaginous plate at each end of a long bone, in children typically closes between 18-25 years old. It is most active when the child is younger. There is no evidence that weight lifting will negatively affect the growth plates. The question that research has failed to answer is: How much stress and strain is too much? A child’s boney structure is not the same as that of an adult. Lifting excessively heavy loads with poor technique could cause damage to these growth plates. In order to insure your child’s safety and limit the risk of injury, his/her weight lifting schedule or program should not be the same as that of an adult.
  • Muscle Strength. Adolescent muscle development will vary widely. It’s highly dependent on proper hormonal balance. Most children don’t have the proper hormonal balance to develop muscle like an adult. Therefore, a child should not be trained as an adult.

Weight training can be appropriate at a young age.  Focus on learning the techniques while developing proper motor patterns and motor control (particularly, if he/she is performing advanced activities such as Olympic weight lifting).  Children’s growth and development tends to occur in spurts.  They often have evolving issues with muscle tightness and asymmetric muscle development.  A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development.  Weight lifting is just one of many training activities for a child.  I highly encourage children to participate in many different activities in order to develop a wide physiological and neurological baseline.

Alexis_Squat

Consider the following when designing a training program for your child:

  • Keep it fun! This is your child’s time to learn and have fun. There is no need to push heavy weights on his/her young body. However, it’s perfectly acceptable to progress strength gains when he/she is able.
  • Develop proper motor programs. Focus on optimizing patterns and mobility. A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development.
  • Encourage variety. For other strength development and motor program development options, encourage body weight exercises such as the TRX system. A CrossFit class, designed specifically for kids, may also be fun option.
  • Proper programming. A child should not be trained as an adult. The exercise programming should be tailored to your child. I recommend an emphasis on technique and a slower progression of resistance and load compared to that of an adult. For young children, double the time it takes for an adult to progress the load. Physical ability will widely vary in the teenage years. Focus on form and technique while developing proper movement patterns. Encourage participation in many different activities in order to develop a wide physiological and neurological baseline. Training volume should be less than an adult.

If your child is experiencing pain or you suspect a developing problem, consult your pediatric physician or a qualified physical therapist about your concerns.  I would also caution you that many pediatric physicians may not be too keen on the idea of weight training in pre-teen children.  Seek a physician who is open to the idea and can work with you and your child to insure optimal health.

As parents, we want to encourage activity and exercise while instilling a life time love of exercise in all of its many forms.  When weight training at a young age, focus on proper ROM and symmetrical strength development.  Thanks, Matt, for the question!

Does your child lift weights and/or participate in sports such as CrossFit?  Why or why not?  Please share your thoughts below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.